Consent for teaching

Consent for teaching was introduced as a result of the Cartwright Inquiry and is part of the Health and Disability Code of Health and Disability Consumer Rights. A consensus statement developed by Otago and Auckland medical schools states that the need to gain consent cannot be set aside on the grounds of inadequate time or resource. This viewpoint argues that a singular focus on patient experience, whilst ignoring the other elements of the quality framework, is not appropriate. "Consent" is a poor word in most circumstances to describe the complex interaction with a patient over time. Rather than strengthening codes of behaviour, an approach of a broader view of the overall quality of the interaction and a focus on cultural safety holds more promise.

Capacity and decision making.

Pickering et al's paper argues that the capacity of the decision-maker is the sole consideration in whether a decision should stand, and that the risk of the decision should not be considered. This argument ignores the existence of the player who is of the view that a decision is not wise. This paper argues that patient autonomy is not the sole determinant of whether a person is able to make an unwise decision, particularly in healthcare where there are always others affected by the patient decision. Rather than asserting that patients have an unfettered autonomous choice on clinical decisions this paper argues that these decisions should be looked at through the lens of quality in health care that has proposed four parameters to be balanced; the patient experience, wise use of resources, the effect on public health and the clinician experience.

Keeping it going: the importance of delivering interprofessional education during the COVID-19 pandemic.

BACKGROUND AND CONTEXT Globally, the coronavirus disease 2019 (COVID-19) pandemic has highlighted the need for better interprofessional collaboration and teamwork. When disciplines have worked together to undertake testing, deliver care and administer vaccines, progress against COVID-19 has been made. Yet, teamwork has often not happened, wasting precious resources and stretching health-care workforces. Continuing to train health professionals during the pandemic is challenging, particularly delivering interprofessional education that often uses face-to-face delivery methods to optimise interactional learning. Yet, continuing to offer interprofessional education throughout the pandemic is critical to ensure a collaboration-ready health workforce. One example is continuing the established INVOLVE (Interprofessional Visits to Learn Interprofessional Values through Patient Experience) interprofessional education initiative. ASSESSMENT OF PROBLEM Educators have not always prioritised interprofessional education during the pandemic, despite its immediate and long-term benefits. The INVOLVE interprofessional education initiative, usually delivered face-to-face, was at risk of cancellation. RESULTS A quality improvement analysis of the strategies used to continue INVOLVE demonstrated that it is possible to deliver interprofessional education within the constraints of a pandemic by using innovative online and hybrid educational strategies. Educators and students demonstrated flexibility in responding to the sudden changes in teaching and learning modalities. STRATEGIES When pandemic alert levels change, interprofessional educators and administrators can now choose from a repertoire of teaching approaches. LESSONS Four key lessons have improved the performance and resilience of INVOLVE: hold the vision to continue interprofessional education; be nimble; use technology appropriately; and there will be silver linings and unexpected benefits to the changes.

How Should We Respond to the Global Pandemic: The Need for Cultural Change

The Covid pandemic has had a terrible effect on the world and government responses have been described as “Catastrophic Moral Failure”. The approach of bioethics of developing “normative ethics” has provided frameworks on how to act but despite the fact that we knew what to do to prevent the pandemic, we did not do it. In this paper I argue that ethics is culture bound: it is the stories that “we” live by. I illustrate this with examples of cultures with differing values that were developed as a result of the particular circumstances of those cultures. I then argue that after World War 2 in response to the risks of further large wars and atrocities, work was done to further establish a “global culture” and a detailed normative ethical framework was developed by negotiation through the United Nations for that “culture”. Whilst this approach has been necessary, it has not been sufficient. I argue that we need to reframe the approach as one of achieving cultural change rather than complying with ethical norms. Some societies that were unable to adapt to changed circumstances failed to survive, others failed to thrive. A similar fate awaits the whole planet if we cannot change the stories we live by.

COVID-19 from Wellington New Zealand.

This paper examines the role of bioethics in the successful control of COVID-19 in New Zealand. After the severe acute respiratory syndrome (SARS) coronavirus episode in Toronto researchers developed a framework of values and principles to articulate values that were already commonly accepted "in the community of its intended users," to be used to inform decision-making. New Zealand subsequently developed its own framework that was embedded in its Pandemic Influenza Plan. These formed the basis of the New Zealand response to COVID-19. This paper illustrates the ways in which the bioethical framework was reflected in the decisions and actions made by the government.